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Study setting the following formula was used assuming two equal sample
sizes for the study and comparison groups, that is n1=n2.
The Military Maternity Hospital in Omdurman (the study
hospital) had two labor rooms and 114 beds, of them 103 beds
were in obstetric unit and 11 were in the nursery. Alribat
hospital (the control) had two labor rooms and 54 beds, 42 in
the obstetric unit and 12 in the nursery. In both hospitals no
breastfeeding training was carried out before.
Where,
Study populations P1 was the EBF rate before the intervention=0.41 [8].
In each hospital there were two study populations. The first P2 was the expected EBF rate after the intervention; it was
was the health care providers of the obstetric and nursery calculated by assuming an expected improvement by 50%. This
units. This included doctors, nurses, midwives and was estimated according to a similar previous study [11]. The
nutritionists. The second population included mothers who sample size was double-checked using the electronic calculator
delivered in the two hospitals and gave birth normally to a from the web site epitools [13]. The final sample size was:
single infant with a gestational age of at least 37 completed n1=n2=108. A systematic random sampling technique was
weeks. Healthcare providers who received breastfeeding applied to select mothers for interview in each hospital.
training before were excluded. Very ill mothers and mothers of
very ill babies were also excluded.
Data collection tools and techniques
Sample size and sampling techniques Four tools were used to collect data. A structured
questionnaire to interview the health care providers before
All eligible health care providers were included in the study: and after intervention (pretest and posttest on the same day
107 in the study and 61 in control hospital. For the mothers, of the training). The same questionnaire was done once in the
control hospital. Another structured questionnaire was used to
interview mothers immediately after delivery to assess the 13. Ways to help a mother with ‘not enough milk, or with a
method of feeding. A checklist which was adapted from WHO baby who is refusing to breastfeed.
baby friendly hospital assessment tools [14] was used to
The bed-side training covered breastfeeding counseling,
assess the midwives' skills with regards to breastfeeding. Then
positioning the baby, latching the baby correctly to the breast
a follow-up phone questionnaire to the mothers was used to
and demonstration of the effective suckling. All the training
enquire about feeding at month one, two, three, and six after
materials were adapted from the WHO Breastfeeding Training
discharge.
Manual [14], and Infant and Young Child Feeding Counseling
All tools were pretested for ambiguity and readability with a Integrated Course [15].
convenience sample in Khartoum teaching hospital. A total of
fifty tests were filled by direct interviews with doctors, nurses, Data analysis
midwives, and nutritionists in the obstetric and nursery
departments. The test took about twenty minutes to be The comparability of the respondents from the study and
completed each time. After this pretest the questions were control hospitals regarding their characteristics: job mix, years
adjusted to be clear and understandable, this included the of experience, age distribution, and their marital status and if
attitude question in which a standard Likert scale could not fit they had children or not was checked. Their Knowledge and
so it was simplified. attitude towards exclusive breastfeeding were also compared.
The responses to the knowledge and attitude questions were
Data was collected by the researcher and two trained data given grades of good, fair, or poor before entry this was
collectors who were supervised by a field supervisor. In-office adapted from the WHO Baby friendly hospital assessment tool
check was carried out by the researcher, immediately after [14]. Chi-squired test was performed and P-value <0.05 was
receiving the data to ensure accuracy, correctness, considered significant. Regarding the baseline assessment of
completeness, and relevance. the skills, there was no observed help for the mothers in either
The post-intervention data was collected after 6 weeks after hospital before training.
the training in both hospitals. This continued for one month The proportions of exclusive breastfeeding at discharge
until the two samples were completed. The mothers were from the hospital, at one, two, three, and six month were
followed up by the researcher through phone interviews. compared between the samples of mothers from the two
hospitals using the Z-test. Data was checked after entry,
The intervention monitored by the researcher, before analysis. The entered data
was analyzed using the software statistical package for social
The intervention comprised two modalities: training
science (SPSS) version 11.5 and Epitools [13].
workshops and bed side training. The contents of the
workshop training were as below,
Ethical approval
Contents of the workshops:
The study was approved by the ethical committee of the
1. Basic anatomy and physiology of the breast. Sudanese medical specialization board (SMSB). Permission
2. Role of breastfeeding and human milk in maintaining from state ministry of health and the concerned hospitals was
health and preventing disease. also obtained. Verbal consent from all the participants was
also ascertained.
3. Definition and importance of exclusive breastfeeding, and
its correlation with optimal health outcomes.
4. Positioning of the baby and latch on the breast and the
Results
effective suck. 168 health care providers, 38 midwives, and 218 mothers
5. Initiation of breastfeeding soon after delivery. were included in this study. The two groups of participants (2
hospitals) were comparable regarding age, marital status and
6. Ways to help lactating mothers with breast or nipple having children or not and the working experience (Table 1
problems. and Table 2).
7. Conditions of illness of the mother or infant. There was no statistically significant difference regarding the
8. Potentially adverse outcomes for infants and mothers distribution of age, marital status and having children or not,
who do not breastfeed. and Job title distribution in the two hospitals. Z-test showed
insignificant values in most of the scores.
9. Potential problems associated with the use of human milk
substitutes. No statistically significant difference in baseline knowledge
10. Breastfeeding counseling. of the health care providers P>0.05 the difference in
knowledge before and after training however was statistically
11. Role of the baby friendly hospital to support significant P-value <0.0001 (Table 3). Regarding attitude
breastfeeding. variables, there was also statistically significant difference
12. Way to help a mother to express her breast milk by hand.
© Copyright iMedPub 3
Annals of Clinical and Laboratory Research 2016
ISSN 2386-5180 Vol.4 No.3:106
after training(p<0.05) (Table 4). After training showed a Doctor 34 (31.8) 25 (41) 1.2 0.2297
difference just significant statistically P=0.049 (Table 4).
Nurse 42 (39.2) 14 (23) 2.1 0.0322
Table 1 Distribution of the participants in the study and control Midwife 22 (20.6) 16 (26) 0.8 0.4207
hospitals according to socio-demographic characteristics
Nutritionist 9 (8.4) 6 (10) 0.3 0.7272
Knowledge variables and Pre intervention post intervention Chi square P- value
grading
Freq. (%) Freq. (%)
Exclusive breastfeeding
Benefits to mothers
Proper positioning
Problematic nipples
Fissured nipples
Engorgement
Night feeding
Effect of formula
Improper latch
Attitude variable and Pre intervention post intervention Chi square P- value
grading
Freq. (%) Freq. (%)
© Copyright iMedPub 5
Annals of Clinical and Laboratory Research 2016
ISSN 2386-5180 Vol.4 No.3:106
© Copyright iMedPub 7
Annals of Clinical and Laboratory Research 2016
ISSN 2386-5180 Vol.4 No.3:106
24. Sheryl W (2009) Exploring the impact of the Baby-Friendly 27. Bartington GL (2006) Are breastfeeding rates higher among
Hospital Initiative on trends in exclusive breastfeeding. Int mothers delivering in Baby Friendly accredited maternity units
Breastfeed J 4: 11. in the UK. Int J Epidem 35: 1178-1186.
25. Chung M, Raman G, Trikalinos T, Lau J (2008) Interventions in 28. http://www.gserve.nice.org.uk/nicemedia/documents/
Primary Care to Promote Breastfeeding: An Evidence Review for breastfeeding_evidencebriefing.pdf
the U.S. Preventive Services Task Force 149: 565-582.
29. Coutinho LM, Ashworth A (2005) Comparison of the effect of
26. Shinwell ESM, Shani M (2006) The Effect of Training Nursery two systems for the promotion of exclusive breastfeeding. The
Staff in Breastfeeding. Breastfeeding Medicine 1: 247-252. Lancet 366: 1094-1100.